The Apgar score is a procedure that obtains the status of the new-born baby directly after being born, as well as the infant’s reaction to resuscitation if necessary. This method should not be associated with causing, or being a consequence of, asphyxia. This means that it doesn’t forsee neonatal mortality or neurological development, and should not be used for that motive. An Apgar score that is obtained during resuscitation is not comparable to a score obtained from a naturally breathing new-born.
According to Andrea Stuart and Petra Otterblad Olausson (2011) the Apgar score was presented in 1952, and aimed to obtain a fast evaluation of the clinical status of infants shortly after birth. This method is still used in delivery rooms worldwide. Research shows that an Apgar score of lower than 7 at 5 minutes after birth has an affiliation with higher risk for developing cerebral paresis, mental retardation, and epilepsy. Modern research also shows a link between low 5-minute Apgar scores and scoring lower on intelligence tests in male subjects in Denmark and Sweden.
Perinatal asphyxia can be used to explain neurologic sequelae in term new-borns. Follow-up studies focus mainly on acute short-term neurological deficiencies, including mental retardation and cerebral palsy. The “continuum of reproductive casualty” theory suggests that serious hypoxic episodes can result in noticeable neurological deficiency and even death. Mild episodes can lead to subtle flaws in cognitive function that are only noticeable as the child becomes older. Mild hypoxic episodes are more frequent than serious episodes, and rarely lead to noticeable neurological abnormalities. A low Apgar score is seen as a weak indicator of asphyxia as a result of its low sensitivity, but some studies have discussed the long-term effects on cognition caused by a low Apgar score. Studies are conducted to attempt measuring the effect of low Apgar score on the long-term neurological development of the infant.
Dr Virginia Apgar, 1952, introduced a fast scoring system as a method of evaluating the clinical status of a new-born at 1 minute after birth, and the need for intervention to establish breathing. Thereafter, Dr Apgar released a second report that dealt with a larger amount of patients. The Apgar score became a customary assessment for new-borns after the birth process. The Apgar score consists of five components including reflexes, respiration, colour, muscle tone, and heart rate. Each of these components is given a score from 0 to 2. Therefore, the Apgar score determines the extent of clinical indicators of neonatal depression, such as pallor or cyanosis, bradycardia, depressed reflex response to stimulation, hypotonia, and apnoea or gasping respirations. The score is obtained at 1 minute and then 5 minutes after birth for all new-borns, and at 5-minute intervals thereafter until 20 minutes for infants with a score of lower than 7.
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Erik Erikson (1958) separated the human lifespan into eight stages. Each stage contains what he calls a psychosocial crisis. Erikson describes personality as being molded through the way individuals handle stressful situations that may include changes in valuable social relationships. Different crises often involve a struggle between two opposite dispositions such as initiative vs guilt or trust vs mistrust that are endured by the individual at a specific stage. These opposed tendencies illustrate personality characteristics that individuals portray in varying ways over the rest of their lives. Even-though the names for Erikson’s stages propose either/ or outcome, every stage forms a balance between polarities in personality. The stage of trust or mistrust covers the first year of life where the new-born depends entirely on their caregivers to satisfy their basic needs in life and will affect whether or not attachment is formed. The stage of autonomy vs shame and doubt takes place during the second and third years of the infant’s life and shows how the infant initiates some personal responsibility for dressing, feeding, and bathing. This stage involves the child starting to potty train which ultimately influences their behaviour provides the child with a sense of independence. This phase often involves a lot of conflict between the parent and child. The next stage, initiative vs guilt, comprises of children from the age of three to six and illustrates children taking more control which often opposes overly protective parent’s rules and may cause the children to feel guilty. Industry vs inferiority, the fourth stage, consists of children from ages six up to puberty challenges the children to learn how to function socially with individuals outside of the family. During this stage the children learn to value increased self-esteem and achievement.
Cognitive maturation refers to enhancements in children’s ways of thinking, including problem-solving, remembering and reasoning. Similar to Erikson, Jean Piaget (1929) also introduced a stage theory of development and suggested that children advance through four main stages of cognitive development that are characterised by different thought processes. These processes include the sensorimotor period, the preoperational period, the concrete operational period, and the formal operational period. Piaget considered his age norms as estimates and recognized that transitional ages do vary. Even so, he was confident that all children experience the stages of cognitive development in the same order. Paget’s theory starts with the sensorimotor period, enduring from birth to around the age of 2.
According to Constantino Arce and Maria Pilar Fernandez (2020), cognitive data of children should be obtained at an early stage to uncover any developmental setbacks or varying patterns of development so that intervention methods can be implemented. As a result, follow-up research of universal cognitive abilities of preterm (PT) children in coexistence with bio-medical, personal and environmental factors linked to cognitive results are of substantial relevance. Evidence illustrates that children who were born preterm, with low Apgar scores, often display cognitive disabilities in different areas when compared to children who were born full-term.
Gestational age (GA) is related to cognitive development, so that a lower GA will lead to a decrease in the cognitive development of preschool, as well as school age, preterm children. Disparities between preterm and full-term children are especially high between extremely preterm and full-term children.
D Gunnell and G Lewis (2008) state that an extremely low Apgar score at 5 minutes after birth is strongly linked to an increased risk of developing neonatal encephalopathy, cerebral palsy (CP), as well as learning disadvantages. However, a low Apgar score can also be caused by factors other than brain injury or intrapartum incidents. The present understanding is that clinically brain damage leading to CP, whether or not learning disability occurs, can only take place if the hypoxic threat is consequential enough to cause clinical encephalopathy in the neonatal interval. The long-term results of children with low Apgar scores who do not develop encephalopathy are deemed to be ordinary with regards to CP. However children with mild neonatal encephalopathy, who do not develop CP, are at risk of developing cognitive disabilities as teenagers.
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